RL 
780 


UC-NRLF 


172 


BY 

JOHN  P.  TURNER.M.D. 


RINGWORM 


AND  ITS 


SUCCESSFUL  TREATMENT 


BY 


JOHN  P.  TURNER,  M.D. 

MEDICAL  INSPECTOR  OF  PUBLIC  SCHOOLS,  PHILADELPHIA,  PA. 


ILLUSTRATED   BY  EIGHT  HALF-TONE 
ENGRAVINGS 


PHILADELPHIA 

F.  A.  DAVIS  COMPANY,  PUBLISHERS 
1921 


BIOLOGY 


COPYRIGHT,   NOVEMBER,   1921 

BY 
F.  A.   DAVIS   COMPANY 


Copyright,  Great  Britain.     All  Rights  Reserved 


PRESS   OF 

F.    A.     DAVIS    COMPANY 
PHILADELPHIA.  U.S.A. 


IN    MEMORY    OF    MY    FATHER 
JESSE  E.  TURNER 


500626 


INTRODUCTION. 


IT  gives  me  pleasure  to  state  that  the 
treatment  of  ringworm  of  the  scalp  devised 
by  Dr.  John  P.  Turner  has  proven  remark- 
ably efficacious  in  his  hands.  In  the  year  1913 
the  Reynolds  Public  School,  Philadelphia, 
with  a  population  of  six  hundred  children  was 
badly  infested  with  ringworm.  About  eighty 
cases  were  discovered,  of  which  at  least  one- 
half  were  ringworm  of  the  scalp.  In  view  of 
the  obstinate  nature  of  the  latter  affection, 
the  proper  conduct  of  the  school  was  a  serious 
problem.  Dr.  Turner  consented  to  undertake 
the  treatment  of  these  cases  in  connection 
with  his  work  as  school  medical  inspector 
and  effected  a  complete  cure — a  remarkable 
achievement  deserving  of  medical  notice. 

WALTER    S.    CORNELL,    M.D. 

Director  Medical  Inspection  of  Public  Schools  of 
Philadelphia,    Penna. 

(5) 


FOREWORD. 


THE  author  offers  this  treatise  be- 
cause of  the  prevalence  of  ringworm, 
and  because  of  the  success  obtained  with 
thousands  of  cases  that  have  come  un- 
der his  care.  For  over  one  hundred  years 
this  disease  has  been  studied  and  various 
treatments  advocated.  Wherever  num- 
bers of  school  children  are  found,  ring- 
worm is  most  apt  to  be  present.  A  neg- 
lected case  in  a  classroom  is  liable  to 
spread  until  many  cases  are  found  in  the 
school  building.  The  personal  appear- 
ance of  the  child  is  interfered  with  by 
the  presence  of  this  malady,  and  in  ad- 
dition there  is  the  discomfort  it  causes 
by  itching  and  scaling.  The  treatment 

(7) 


Foreword. 


used  by  the  writer  is  simple,  easy  of  ap- 
plication and  inexpensive.  Any  parent 
or  guardian  can  apply  it.  Many  cases 
of  ringworm,  especially  of  the  scalp, 
are  obstinate  to  most  treatments.  Usu- 
ally ringworm  is  neglected.  In  order 
to  obtain  results,  daily  treatments  must 
be  systematically  given.  Many  children 
have  ringworm  of  the  scalp,  and  the 
parents  are  unaware  of  its  presence  until 
it  has  developed  sufficiently  to  be  very 
obstinate  to  ordinary  treatment.  As  soon 
as  the  smallest  patch  or  ring  is  noticed, 
if  instructions  given  in  the  Chapter  on 
Treatment  are  followed,  a  speedy  cure 
may  be  expected.  In  chronic  and  severe 
cases,  the  rapidity  with  which  results 
are  obtained  is  most  remarkable. 

The    treatment    to    be    described    has 
been  used  by  the  author  for  nearly  ten 


Foreword. 


years.  When  originated,  he  had  under 
his  care  the  pupils  of  a  school  where 
existed  eighty  severe  cases  of  ringworm 
of  the  scalp  and  face.  In  order  to  check 
the  rapidly  spreading  disease,  immediate 
and  drastic  steps  had  to  be  taken.  The 
result  was  the  working  out  of  what  is 
to  be  given  in  the  Chapter  on  Treatment. 
Before  describing  the  remedies  used, 
we  shall  discuss  the  history  of  ring- 
worm, its  diagnosis,  differential  diagno- 
sis, and  pathology. 

J.  P.  T. 


CONTENTS. 


I.     THE  HISTORY  OF  RINGWORM 15 

II.     THE  PATHOLOGY  OF  RINGWORM  18 

III.  THE  DIAGNOSIS  OF  RINGWORM 24 

IV.  THE     DIFFERENTIAL     DIAGNOSIS     OF 

RINGWORM  40 

V.     How  RINGWORM  is  SPREAD 52 

VI.     THE  TREATMENT  OF  RINGWORM 54 

VII.  WHEN  is  RINGWORM  CURED?  .            .  58 


ILLUSTRATIONS. 


1.  How  a  ringworm  grows   21 

2.  Ringworm  of  scalp 25 

3.  Ringworm1  of  scalp 29 

4.  Ringworm  of  the  face 33 

5.  Ringworm  of  the  hand 37 

6.  Ringworm  of  scalp 41 

7.  Ringworm  of  scalp.    Diffuse  case 45 

8.  Ringworm  of  scalp 49 


(13) 


CHAPTER    I. 
THE  HISTORY  OF  RINGWORM. 

THIS  affection  was  first  described  by 
Willan,  in  1817,  and  Plumbe,  in  1821. 
At  that  time,  however,  it  was  not  under- 
stood. It  was  confounded  with  alopecia, 
eczema,  and  seborrhea.  Credit  is  given 
to  Gruby,  of  Paris,  in  1843,  f°r  discovery 
of  a  fungus  in  the  broken  off  hairs  of 
ringworm  areas.  To  this  fungus  he  gave 
the  name  of  Microsporon  aitdouini.  Un- 
fortunately he  called  the  disease  "Porrigo 
Decalvans."  This  term  had  already  been 
used  by  Bateman  in  describing  alopecia 
areata.  As  a  result,  for  a  long  time  there 
was  a  confusion  between  these  two  con- 
ditions. Later  on  Sabouraud  (1894), 

(15)  ' 


•1.6 


History  of  Ringworm. 


through  his  discoveries,  cleared  up  these 
misunderstandings.  The  fungus  of  ring- 
worm was  named  Trichophyton  tonsurans 
by  Malmsten  in  Stockholm,  in  1845.  F°r~ 
merly  it  was  believed  all  varieties  of  ring- 
worm were  due  to  this  one  distinct  species 
of  fungus.  Now  it  is  known  there  are 
various  fungi  causing  the  different  forms 
of  the  disease. 

In  1894  Sabouraud  published  a  work 
on  the  nature  of  the  Tinea,  in  which  he 
divided  the  Tinea  tonsurans  into  two 
distinct  groups : 

(A)  Tinea  with  small  pores  (which  is 
due  to  the  fungus  called  Micro- 
sporon  audouini). 

(B)  Tinea  with  large  spores  (due  to 
various    forms    of    the    Tricho- 
megalosporon). 


History  of  Ringworm.  17 

The  small  spore  Tinea  is  the  common 
form  of  ringworm,  the  large  spore  the 
rarer  form. 

Fifty  years  ago  ringworm  was  very 
prevalent  in  England.  School  children  in 
large  numbers  wrere  sufferers. 


CHAPTER  II. 
THE  PATHOLOGY  OF  RINGWORM. 

THE  pathology  of  ringworm  is  that 
of  a  specific  inflammation.  The  skin  is 
altered  in  color,  due  to  congestion,  al- 
tered in  sensation,  due  to  the  effect  of 
the  foreign  substance  produced  by  the 
fungus,  anxl  altered  in  the  size  of  the 
part  affected,  due  to  enlargement  of  the 
blood-vessels.  There  is  present  a  des- 
quamation  of  the  skin,  and  sometimes 
there  is  a  serous  or  purulent  discharge 
with  crust  and  scab  formation.  The 
eruption  caused  by  the  fungus  is  super- 
ficial, leaving  no  permanent  destruction 
of  the  upper  or  deeper  layers  of  the 
skin. 

(18) 


Pathology  of  Ringworm.  19 

THE  FUNGUS. 

The  fungus  consists  of  branching 
hollow  tubes  called  mycelium,  and  of 
spores.  These  spores  may  grow  into 
mycelium  tubes.  The  transition  is 
formed  by  a  protrusion  in  the  cell  wall 
and  then  by  an  increase  in  this  projec- 
tion. In  ringworm  of  the  body,  the  my- 
celium is  large  and  abundant. 

INVASION    OF    THE    HAIRS. 

The  view  confirmed  by  Balzer  in  1883, 
and  substantiated  by  many  since,  is  that 
the  mycelium  enters  the  orifice  of  the  hair 
follicle,  insinuates  itself  between  the  hair 
shaft  and  inner  root  sheath,  and  passing 
down  till  it  reaches  the  softer  cells  of  the 
bulb,  enters  the  hair.  It  then  multiplies 
and  ramifies  between  the  fibres  of  the 
hair.  However,  it  is  possibly  best  that 


20  Pathology  of  Ringworm. 

no  given  rule  be  laid  down  as  to  where 
the  fungus  first  attacks  the  hair.  It  is 
always  in  the  follicular  portion  and  often 
toward  the  root  end,  but  sometimes  in 
one  place  and  sometimes  in  another.  The 
fungus  rapidly  grows  in  and  on  the 
hairs,  rendering  them  lustreless,  opaque 
and  brittle.  They  therefore  easily  break 
off  near  the  surface  of  the  scalp  forming 
the  so-called  "stumps."  The  fungus  does 
not  flourish  in  living  tissue.  It  is  not 
found  beyond  the  epidermic  strata. 

ACTION  OF  THE  FUNGUS. 

When  brought  into  contact  with  the 
skin  it  passes  between  the  superficial 
cells  of  the  epidermis  and  finds  its  way 
into  the  deeper  layers.  Here  it  develops 
and  causes  an  inflammation,  forming  first 
a  ring  of  small  papules,  followed  by  ves- 


Fig.  1. — How  a  ringworm  grows.     Highly  magnified. 


(21) 


Pathology  of  Ringworm.  23 

icles  and  possibly  crusts.  As  the  ring 
spreads,  the  hyperemia  in  the  center  dis- 
appears and  desquamation  follows  (Fig. 
i).  If  the  scalp  is  involved  and  the 
fungus  is  the  one  that  causes  Tinea  ton- 
surans,  the  hairs  are  quickly  involved, 
causing  the  characteristic  scaling  patches 
with  the  broken  off  stumps  of  hairs 
showing  in  the  affected  area. 


CHAPTER  III. 
THE  DIAGNOSIS  OF  RINGWORM. 

As  it  relates  to  school  children,  there 
are  two  varieties  of  ringworm.  Ring- 
worm of  the  scalp  (Tinea  tonsurans) 
(Fig.  2)  and  ringworm  of  the  body 
(Tinea  circinata)  (Fig.  4).  Ringworm 
of  the  inner  thighs  and  perineum  (Tinea 
cruris)  need  not  be  considered  in  the 
case  of  children. 

RINGWORM    OF   THE    SCALP. 

This  form  of  the  disease  attacks  chil- 
dren almost  exclusively,  being  hardly 
ever  seen  in  an  adult.  It  is  first  noticed 
as  a  pea-sized  scaly  patch.  It  may  en- 
large to  the  size  of  a  silver  dollar  'or 
even  larger.  There  may  be  one  or  more 
(24) 


Fig.  2. — Ringworm  of  scalp.     Tinea  tonsurans. 
After  Schamberg. 

(25) 


Diagnosis  of  Ringworm.  27 

of  these  patches,  or  the  entire  scalp 
may  be  involved.  When  fully  developed 
the  patches  are  usually  circular  in  out- 
line, slightly  elevated  above  the  normal 
surface,  covered  with  scales,  and  some- 
times have  a  number  of  little  follicular 
elevations.  Over  the  diseased  area  are 
found  ends  of  broken  off  hairs.  The 
color  of  the  patches  varies  according  to 
the  complexion  of  the  patient.  In  darker 
skins  they  are  grayish  or  slate  color, 
while  on  white  children  they  are  inclined 
to  be  more  of  a  pinkish  hue.  The  diag- 
nosis of  ringworm  of  the  scalp  is  not 
difficult,  although  there  are  a  few  con- 
ditions that  are  at  times  confused  with 
it.  The  most  important  point  to  remem- 
ber is  the  existence  of  scaling  patches 
with  broken  off  hairs  projecting  here  and 
there  (Fig.  3).  A  magnifying  glass  will 


28  Diagnosis  of  Ringworm. 

readily  reveal  this  condition  in  case  it  is 
not  possible  to  see  it  with  the  naked  eye. 
If  there  is  any  doubt,  the  use  of  the 
microscope  will  settle  the  matter.  The 
presence  of  the  fungus  will  clinch  the 
diagnosis  of  ringworm. 

KERION. 

(Pustular  Ringworm  of  Scalp.) 

This  form  of  ringworm  arises  when 
deep  folliculitis  occurs.  The  patch  swells 
up  and  appears  as  a  subcutaneous  ab- 
scess. The  disease  embodies  one  or 
more  patches  which  are  red,  tender, 
semi-fluctuant,  soft  and  swollen.  Many 
of  the  hairs  come  out  while  a  few  may 
remain  for  a  time.  These  are  easily 
pulled  out  without  the  usual  breaking 
off.  They  are  loosened  by  the  exudate 
formation. 


Fig.  3. — Ringworm  of  scalp.     Tinea  tonsurans. 


(29) 


Diagnosis  of  Ringworm.  31 

While  Kerion  presents  a  worse  pic- 
ture, it  will  cure  itself  quicker  than  ordi- 
nary Tinea  tonsurans.  The  reason  is, 
that  after  a  time  the  hairs  over  the 
patch  all  come  out,  the  inflammation 
subsides  and  new  hairs  grow.  We  are 
not  troubled  with  the  stumps. 

STUMPS. 

A  distinction  must  be  made  between 
healthy  short  hairs  and  stumps.  The 
term  "stumps"  should  be  restricted  to 
diseased  short  hairs  about  an  eighth  or 
a  quarter  of  an  inch  long,  broken  off 
near  the  surface  of  the  skin.  They  are 
swollen,  lustreless  and  usually  break  off 
when  the  attempt  is  made  to  pull  them 
out.  The  reason  they  are  so  fragile  is 
because  they  are  impregnated  with  fungi. 
In  chronic  cases,  stumps  are  sometimes 


32  Diagnosis  of  Ringworm. 

difficult  to  find.  They  may  be  hidden 
among  the  long  hairs,  .on  a  patch,  or 
under  a  scab.  At  other  times  the  stumps 
may  be  found  lying  close  on  the  surface 
of  the  skin,  sometimes  glued  to  the  scalp 
with  a  sticky  sebaceous  matter. 

HOW    TO    PREPARE    THE    SLIDE. 

Pull  out  two  or  three  of  the  broken 
off  hairs  and  place  on  a  slide  with  a  drop 
of  liquor  potassae  (a  forty  per  cent,  solu- 
tion of  caustic  potash).  Permit  this  to 
stand  for  fifteen  minutes,  then  under  a 
power  of  two  hundred  and  fifty  diam- 
eters the  fungus  and  the  lesion  of  the 
hair  will  be  visible. 

RINGWORM    OF   THE    BODY. 

This  form  of  ringworm  is  most  often 
found  on  the  face  (Fig.  4).  It  is  char- 


Fig.  4. — Ringworm  of  the  face.     Tinea  circlnata. 
After  Schamberg. 


(33) 


Diagnosis  of  Ringworm.  35 

acterized  by  the  presence  of  rounded 
sharply  circumscribed,  pinkish  or  gray- 
ish scaly  patches.  These  areas  often 
clear  up  in  the  center  causing  a  ring- 
like  formation.  The  affected  part  is 
raised  above  the  surrounding  skin.  It 
sometimes  itches.  The  presence  of  the 
fungus  determines  the  diagnosis.  The 
examination  of  a  specimen  under  the 
microscope  is  made  as  follows :  Scrape  a 
few  of  the  scales  with  a  knife  blade  and 
place  upon  a  slide,  containing  a  drop  of 
liquor  potassae.  Over  this  place  a  thin 
glass  cover.  Press  the  cover  down  and 
permit  the  specimen  to  remain  for  a  few 
minutes.  The  fungus  will  be  detected 
here  and  there. 

Sometimes  brothers  and  sisters  in  a 
family  with  one  obstinate  case  of  ring- 
worm remain  free  from  the  complaint. 


36  Diagnosis  of  Ringworm. 

In  some  children  the  fungus  takes  but 
slight  hold  and  is  easily  destroyed.  In 
others  the  disease  takes  rapid  hold  and 
3preads  quickly.  The  state  of  the  soil 
(skin)  has  much  to  do  with  the  growth 
of  the  fungus.  Many  writers  contend 
there  must  be  present  some  constitu- 
tional ailment,  lowering  the  natural  re- 
sistance, in  order  for  the  fungus  of  ring- 
worm to  gain  lodgement  and  grow.  It 
has  been  observed  by  some  that  children 
of  pallid,  sickly  natures  are  the  most  sus- 
ceptible victims.  Malcolm  Morris  wrote 
in  1 88 1  that  children  with  golden  or 
colorless  hair,  with  gray  or  blue  eyes, 
and  with  a  very  fine  skin,  were  the  most 
often  affected.  In  the  experience  of  the 
writer,  this  is  not  true.  In  this  country, 
among  Caucasians,  the  more  swarthily 
complexioned  seem  to  be  the  greater 


Fig.  5. — Ringworm  of  the  hand.     Tinea  circinata. 
After  Schamberg. 

(37) 


Diagnosis  of  Ringworm.  39 

sufferers;  while  Negro  children  furnish 
the  richest  soil  for  the  development  and 
growth  of  ringworm.  Three-fourths  of 
the  number  of  cases  of  this  disease  re- 
ported to  the  Bureau  of  Health  in  Phil- 
adelphia during  the  past  year,  were  from 
Negro  children.  It  is  also  the  experience 
of  the  writer  that  robust,  and  to  all  ap- 
pearances healthy  children,  have  ring- 
worm as  violently  as  the  ill  nourished. 
There  seems  to  be  a  certain  condition 
present  in  the  skin,  the  nature  of  which 
is  obscure,  which  invites  the  growth  of 
the  germ. 


CHAPTER  IV. 

THE  DIFFERENTIAL  DIAGNOSIS  OF 
RINGWORM. 

IN  order  to  be  able  to  discriminate 
between  this  affection  and  those  condi- 
tions that  might  be  confused  with  it,  we 
shall  discuss  briefly  a  few  of  them. 

SIMPLE  ECZEMA  OF  THE  SCALP. 

This  disease  is  attended  with  consid- 
erably more  itching.  It  is  usually  spread 
over  a  larger  area,  and  not  limited  to 
well  defined  patches.  The  broken  off 
hairs,  which  are  characteristic  of  ring- 
worm, are  not  present.  The  hairs  of 
ringworm  are  easily  pulled  out  while  in 
eczema  they  are  as  a  rule  firmly  im- 
bedded. 
(40) 


Fig.  6. — Ringworm  of  scalp.     Tinea  tonsurans. 


(41) 


Differential  Diagnosis  of  Ringworm.       43 


PEDICULOSIS    CAPITIS. 
(Head  Lice.) 

Itching  is  one  of  the  chief  symptoms. 
It  is  found  mainly  on  the  back  of  the 
head.  Inflamed  patches  are  present  on 
which  are  found  signs  of  scratching. 
The  patches  are  small  and  the  hairs  are 
matted  and  moist.  There  is  an  absence 
of  stumps  of  hairs.  The  presence  of 
pediculi  confirm  the  diagnosis. 

SEBORRHEA    CAPITIS. 
(Dandruff.) 

Dandruff  is  a  condition  caused  by  an 
excessive  secretion  of  sebum.  The  hairs 
are  matted  together.  The  scales  are 
smaller  and  much  greater  in  number  than 
those  found  in  ringworm.  They  stick  to 
the  skin  which  is  not  inflamed. 


44       Differential  Diagnosis  of  Ringworm. 
PSORIASIS  CAPITIS. 

This  disease  occurs  in  small  or  large 
patches.  It  runs  a  chronic  course.  The 
scales  on  the  patches  are  thicker  than  in 
ringworm.  Usually  there  is  a  history  of 
psoriasis  on  other  parts  of  the  body. 
The  hairs  on  the  scalp  are  found  to  be 
growing  unbroken  in  the  patch. 

ALOPECIA    AREATA. 

(Baldness  in  Areas.) 

This  is  the  affection  with  which  ring- 
worm is  most  often  confused.  The  diag- 
nosis between  the  two  is  usually  not  diffi- 
cult. In  alopecia  areata  there  is  an  ab- 
sence of  scales  and  stumps  over  the  bald 
spot.  Around  the  margin  of  the  bald- 
ness we  often  find  short  stumps  of  hair. 
These  should  not  be  confused  with  those 
of  ringworm,  as  they  are  all  broken  off 


Fig.  7. — Ringworm  of  scalp.     Tinea  tonsurans. 
Diffuse  case. 


(45) 


Differential  Diagnosis  of  Ringworm.       47 

on  a  level  with  the  skin.  The  micro- 
scope will  settle  the  diagnosis  if  in 
doubt. 

IMPETIGO  CONTAGIOSA. 

This  disease  is  characterized  by  the 
formation  of  discrete  flat  vesicles  which 
turn  rapidly  to  pustules  and  then  form 
crusts.  It  is  highly  contagious.  The 
vesicles  range  in  size  from  a  pin  head  to 
a  pea  or  even  larger.  There  are  present 
no  stumps  of  hairs  as  in  ringworm.  Im- 
petigo appears  on  either  the  scalp  or 
body.  Aldersmith  writes  concerning  this 
disease :  "Impetigo  is  sometimes  thought 
to  be  ringworm.  The  rapidly  spreading 
form  of  pustular  ringworm  (Kerion) 
closely  simulates  Impetigo  contagiosa." 
Impetigo  is  common  in  the  occipital 
region  of  the  scalp.  This  is  especially 
true  when  complicated  with  pediculosis. 


48      Differential  Diagnosis  of  Ringworm. 

Some  writers  regard  as  the  cause  of  im- 
petigo a  particular  fungus,  while  others 
contend  micrococci  are  the  root  of  the 
trouble.  A  microscopical  examination 
will  determine  the  presence  or  absence  of 
ringworm  if  in  doubt.  Impetigo  does 
not  spread  in  schools  as  does  ringworm. 
It  is  found  often  in  several  members  of 
the  same  family. 

SYPHILITIC  ERUPTIONS. 

Many  of  these  may  resemble  Tinea 
circinata.  Itching  is  not  present  and  as 
a  rule  the  eruption  is  more  symmetrical. 
The  history  will  aid  in  diagnosis. 

HERPES  IRIS. 

In  this  condition  we  find  a  number  of 
vesicles  and  papules.  Often  the  vesicles 
are  arranged  so  as  to  form  distinct 


Fig.  8. — Ringworm  of  scalp.     Tinea  tonsurans. 


(49) 


Differential  Diagnosis  of  Ringworm.       51 

rings.  When  one  ring  is  fully  formed, 
another  sometimes  forms  around  it.  If 
in  doubt,  the  microscope  will  determine. 

ERYTHEMA  CIRCINATUM. 

This  and  other  varieties  of  erythema 
are  often  mistaken  for  Tinea  circinata. 
Erythematous  patches  are  often  symmet- 
rical. They  have  well  defined  edges, 
which  are  raised  and  thickened. 


CHAPTER  V. 
How  RINGWORM   is  SPREAD. 

RINGWORM  is  spread  through  simple 
contact.  Hairdresser's  and  barber's  tools 
are  not  infrequent  conveyers.  The 
fungus  may  be  carried  from  one  child 
to  another  by  towels,  brushes  and  other 
utensils  used  in  common;.  Often  ring- 
worm exists  in  a  child's  head  unknown 
to  its  parents.  Such  a  child  is  a  source 
of  contagion  to  its  playmates.  Children 
in  play  often  pass  their  hands  through 
each  others'  hair,  put  on  each  others' 
hats  or  rub  their  heads  together.  Adults 
not  infrequently  contract  ringworm  of 
the  body  by  handling  and  treating  ring- 
(52) 


How  Ringworm  is  Spread.  53 

worm  of  the  scalp.  It  is  quite  possible 
the  disease  is  spread  by  the  promiscuous 
piling  together  of  wraps  and  hats  in  a 
school  closet. 


CHAPTER  VI. 

THE  TREATMENT  OF  RINGWORM  OF  THE 
SCALP  AND  BODY. 

THE  SCALP. 

IN  severe  cases,  have  all  the  hair  cut 
close.  If  there  is  only  one  isolated  patch, 
cut  the  hair  close,  the  radius  of  an  inch 
all  around  the  area  involved.  The  treat- 
ment consists  of  four  stages  each  occupy- 
ing a  few  days,  then  a  repetition  if  neces- 
sary. 

First  Stage: 

(Daily  for  four  days.) 

Scrub  the  scalp  or  patch  with  castile 
soap  and  warm  water. 

Then    apply    with    a    cotton    probe, 
tincture  of  iodine. 
(54) 


Treatment  of  Ringworm.  55 

Second  Stage: 

(Daily  for  three  days.) 
Following    the    scrubbing,    rub    into 
the  parts  thoroughly  oil  of  cade. 

Third  Stage: 

(Daily  for  three  days.) 

Following  the  scrubbing  apply,  by 
rubbing  into  the  parts,  ammoniated  mer- 
cury ointment  20  per  cent,  strength. 

Fourth  Stage: 

(Daily  for  three  days.) 

Following  the  scrubbing,  rub  into 
the  parts  resorcin  ointment  20  per  cent, 
strength. 

Continue  the  treatment  if  necessary 
by  beginning  all  over  and  going  through 
the  same  routine  until  cured.  Mild  cases 
will  yield  readily,  and  the  most  obstinate 


56  Treatment  of  Ringworm. 

will  soon  show  signs  of  improvement. 
From  one  to  fifteen  courses  of  treatment 
will  be  necessary.  Few  cases  fail  to 
yield  to  four  courses  of  treatment. 

THE  BODY. 

There  are  two  stages: 
First  Stage: 

(Daily  for  three  days.) 

After  thoroughly  scrubbing  the  af- 
fected area  with  castile  soap  and  warm 
water,  paint  over  the  part  with  tincture 
of  iodine.  In  case  the  ringworm  is  on 
the  face  it  is  well  to  use  colorless  iodine. 

Second  Stage: 

After  cleansing  with  castile  soap  and 
warm  water,  rub  into  the  parts  ammoni- 
ated  mercury  ointment  20  per  cent, 
strength. 


Treatment  of  Ringworm.  57 

Continue  the  treatment  until  the  ring- 
worm disappears.  This  will  require 
from  one  to  four  courses  of  treatment. 


CHAPTER  VII. 
WHEN  is  RINGWORM  CURED? 

THIS  question  is  often  asked,  particu- 
larly in  reference  to  the  return  to  school 
of  children  who  have  been  suffering  with 
the  disease. 

THE  SCALP. 

Ringworm  of  the  scalp  cannot  be  said 
to  be  cured  until  the  entire  scalp  is  care- 
fully examined  with  a  magnifying  glass 
to  ascertain  if  there  are  any  stumps  of 
hair  present.  Absence  of  the  fungus 
upon  microscopic  examination  is  an  im- 
portant determining  factor. 

Hair  may  be  growing  over  the  form- 
erly bald  spot,  but  if  the  broken  off  hairs 
are  found,  the  case  is  not  cured. 
(58) 


When  is  Ringworm  Cured?  59 

THE  BODY. 

A  patient  with  Tinea  circinata  cannot 
be  pronounced  cured  until  the  margins  of 
the  patch  are  free  from  all  papules  and 
desquamation.  The  area  should  no  longer 
be  raised  above  the  surrounding  surface. 
If  there  is  doubt,  the  skin  just  inside  the 
margin  of  the  patch  should  be  scraped  and 
examined  under  the  microscope  for  the 
presence  of  the  fungus.  If  found  the  .case 
is  not  cured.  Sometimes  we  are  unable 
to  find  any  fungi  in  the  specimen,  yet 
the  disease  is  still  present.  Stop  all 
treatment  and  watch  for  a  recurrence  of 
papules  and  scales. 

DOES  ONE  ATTACK  RENDER  IMMUNITY 
AGAINST  ANOTHER? 

Many  people  are  under  the  false  im- 
pression that  one  attack  of  ringworm 


60-  When  is  Ringworm  Cured? 

gives  the  child  an  immunity  against  fur- 
ther attacks.  Even  after  new  healthy 
hair  has  grown  on  a  previous  patch,  the 
disease  has  been  known  to  commence 
again  on  the  old  spot.  In  most  of  such 
cases,  the  old  attack  was  never  properly 
cured;  the  next  infection  starting  from 
the  stumps  that  had  been  quiescent. 

SOME    CHARACTERISTICS    OF 
RINGWORM. 

It  is  contagious. 

It  is  more  prevalent  among  boys  than 
girls. 

Found  more  frequently  among  Negro 
children  than  among  white. 

Its    presence    gives    an    objectionable 
appearance  whether  on  the  face  or  scalp. 

Ringworm  of   the   scalp   if  neglected 


When  is  Ringworm  Cured?  61 

will    form    layers    of    scales,    which    peel 
off. 

If  through  neglect  or  otherwise,  ring- 
worm persists  through  childhood,  it  dis- 
appears when  the  child  reaches  the  age 
of  fifteen  or  sixteen.  There  appears  to 
be  some  unexplained  change  in  the  skin, 
as  a  soil  for  the  growth  of  the  germ  at 
that  period  of  life. 

SOME  DON'TS  IN  THE  CARE  OF  RING- 
WORM CASES. 

Don't  neglect  a  case  no  matter  how 
trivial  in  appearance. 

Don't  place  on  the  head  the  hat  or 
cap  of  another  suffering  with  ringworm. 

Don't  allow  the  use  of  a  towel  or 
other  article  that  has  been  in  contact 
with  ringworm. 


62  When  is  Ringworm  Cured? 

Don't  fail  to  wear  a  skull  cap  if  a 
scaling  ringworm  of  the  scalp  exists. 

Don't  apply  vaseline  or  grease  to  ring- 
worm patches  for  the  sake  of  hiding 
them.  These  applications  have  no  cura- 
tive effect. 

Don't  permit  the  hair  to  grow  long 
if  ringworm  is  present.  Keep  it  short. 


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